Basic Information
| Provider Information | |||||||||
| NPI: | 1013678135 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SIMPLY VAX, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SIMPLY VAX, PLLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 239 W 67TH CT | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805381177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705990330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 239 W 67TH CT | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805381177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705990330 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2022 | ||||||||
| LastUpdateDate: | 01/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | RHOADS | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9705990330 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.